Individual
MISS NICKEY LEE PAISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3501 WRIGHT AVE, RACINE, WI 53405-3349
(262) 637-4411
Mailing address
3501 WRIGHT AVE, RACINE, WI 53405-3349
(262) 637-4411
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
10/19/2006
Last updated
07/08/2007
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